Provider Demographics
NPI:1043638042
Name:CANTU-MANLEY, HAYDEE (MD)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:CANTU-MANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAYDEE
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:241 COMMERCE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3538
Mailing Address - Country:US
Mailing Address - Phone:815-524-2200
Mailing Address - Fax:877-461-6742
Practice Address - Street 1:241 COMMERCE DR STE 102
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3538
Practice Address - Country:US
Practice Address - Phone:815-524-2200
Practice Address - Fax:877-461-6742
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.143787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine